Organization
DENTAL BOAT CLUB P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAIDUONG H NGUYEN DDS (OWNER)
(213) 862-0106
Entity
Organization
Contact information
Practice address
4625 BOAT CLUB RD, STE 225, FORT WORTH, TX 76135-7022
(817) 666-8110
Mailing address
4625 BOAT CLUB RD., SUITE 225, FORT WORTH, TX 75135
(817) 666-8110
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
22593
TX
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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